Provider Demographics
NPI:1699068031
Name:KRIKOR DERBABIAN, DDS, INC.
Entity type:Organization
Organization Name:KRIKOR DERBABIAN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIKOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-568-9054
Mailing Address - Street 1:724 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4524
Mailing Address - Country:US
Mailing Address - Phone:805-928-0340
Mailing Address - Fax:805-928-7580
Practice Address - Street 1:724 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4524
Practice Address - Country:US
Practice Address - Phone:805-928-0340
Practice Address - Fax:805-928-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391451223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty